Agreement Reached in Complaint Filed by Latino HIV Patient

An Austin, Texas orthopaedic surgeon has agreed that he and his staff
will not deny or withhold medically appropriate treatment from patients
solely because they are HIV-positive, according to the U.S. Department
of Health and Human Services (HHS). Under a settlement agreement
reached with HHS' Office for Civil Rights (OCR), the surgeon, whose
practice group sees an average of 200 patients per week, will establish
a non-discrimination policy, make reasonable modifications to his
procedures to avoid discrimination against individuals living with
HIV/AIDS, receive comprehensive training, implement patient grievance
procedures, and inform patients of their right to file a complaint with
OCR.

The settlement agreement will bring the surgeon into compliance with
Section 504 of the Rehabilitation Act of 1973 (Section 504). Section
504 requires recipients of federal financial assistance (often health
care providers reimbursed by Medicare or Medicaid) to ensure that
qualified individuals with disabilities, including those with HIV/AIDS,
have equal access to their programs, services or activities.

"Medical providers covered by Section 504 have a legal obligation to
provide medically appropriate services to qualified individuals with
disabilities," said OCR Director Georgina Verdugo. "Under Section 504,
medical providers may not deny or withhold medically appropriate
treatment, as determined by reasonable medical judgment given the
current state of medical knowledge, solely on the basis of a patient's
HIV status. As our investigation, violation finding, and settlement of
this Austin case demonstrate, OCR is committed to ensuring that all
qualified individuals with disabilities -- including those with HIV/AIDS
-- are afforded equal access to quality medical services."

The prevalence of HIV/AIDS in the greater Austin area has increased 63
percent since 2000 and is the third highest in the State of Texas,
according to a Dec. 31, 2007, report of the Austin/Travis County Health
and Human Services Department. Over 1.5 million people reside in the
Austin Transitional Grant Area (TGA), which was established under the
Ryan White Comprehensive AIDS Resources Emergency (CARE) Act and
includes Bastrop, Caldwell, Hays, Travis and Williamson counties.
Medicaid enrolls 7.3 percent of the Austin TGA and nearly 25 percent of
the population does not have public or private health insurance. For
individuals living with HIV/AIDS in the Austin TGA, 49.9 percent are
Caucasian, 24.8 percent are Latino, and 24.2 percent are
African-American.

The settlement with the Austin orthopaedic surgeon was negotiated
following OCR's investigation of an administrative complaint filed by a
Latino male patient living with HIV. The patient, a Medicaid
beneficiary, sought medical treatment for a knee injury and informed the
surgeon of his HIV status. The surgeon contended that if he performed
surgery on the man's knee (a bone-tendon-bone Reconstruction), blood
would splatter and possibly expose him to HIV disease. Due to the
patient's HIV status, the Austin surgeon referred the patient to another
surgeon located over 200 miles away.

OCR found that the Austin surgeon violated Section 504 by refusing to
perform the surgery and instead referring the patient to another
surgeon. In making its determination, OCR relied on the expert opinion
of a physician and medical epidemiologist from the National Center for
Infectious Diseases at HHS' Centers for Disease Control and Prevention
(CDC). The CDC expert opined that practicing effective "universal
precautions" -- medical guidelines for the prevention and management of
exposures to blood and body fluids -- would have been the appropriate
course of action for the Austin surgeon, instead of refusing to perform
the surgery.

"At CDC, we are committed to ensuring that HIV/AIDS treatment decisions
are based on the latest scientific evidence," said Thomas R. Frieden,
M.D., M.P.H., director of the CDC. "We appreciate the opportunity to
provide expert consultation on the risks of HIV exposure in health care
settings."

Under the settlement, the Austin surgeon will receive comprehensive
training on current HIV treatment protocols, universal precautions, and
infection control procedures. The Texas/Oklahoma AIDS Education and
Training Center, funded by HHS' Health Resources and Services
Administration (HRSA), has offered to provide the Austin surgeon with
interactive, hands-on training and on-site clinical consultation.
HRSA's AIDS Education and Training Centers (AETC) Program supports a
network of 11 regional centers (and more than 130 local performance
sites) that conduct targeted, multi-disciplinary, free and low-cost
training to health care professionals working with existing and emerging
populations affected by HIV.

HRSA Administrator Mary Wakefield, Ph.D., R.N., stated, "We are pleased
that one of our AIDS Education and Training Center grantees has offered
this service to a health care professional as part of an OCR settlement
agreement. A key part of our mission is improving the quality of care
received by patients living with HIV/AIDS and providing high quality
education and training to health care professionals is an essential part
of that effort."